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227 Cards in this Set

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Thoracic vertebrae have _____ on vertebral bodies for articulation with ribs.
Superior and inferior costal demifacets.
Transverse process of thoracic vertebrae have costal facets for articulation with ribs except:
T9-12.
Sternum from T_ - T_?
T5-T9.
3 parts of the sternum:
Manubrium, body, xiphoid process.
Sternal angle is the angle between:
Manubrium and sternal body.
Sternal angle (angle of Louis) corresponds to:
T4 and rib 2.
Xiphoid process marks the:
Central tendon of diaphragm, inferior border of heart, superior limit of liver.
Costal ribs slat inferiorly/superiorly?
Inferiorly.
True ribs:
1-7. Attach to the sternum directly through costal cartilage.
False ribs:
8-10. Attach to the cartilage of the rib above them.
Floating ribs:
11-12. Do not connect with the sternum.
1st rib:
Atypical; has scalene tubercle for attachment of scalenus anterior, and grooves for subclavian artery and vein.
Intercostal spaces are named after the ribs above/below them?
Above.
Which rib is not palpable?
1st rib.
What may sternal fractures suggest?
Underlying mediastinal injury.
What is the procedure for making an incision into the chest wall called?
Thoracotomy.
Thoracotomy is the:
Incision of the chest wall to gain access to the pleural cavity.
How does the movements of thoracic wall and diaphragm cause air to enter the lungs?
Pulls on parietal pleura, transpulmonary pressure tugs on visceral pleura, decreases intrapulmonary pressure, hence drawing air in.
Two types of movement of the thoracic wall:
Pump-handle movement: increase anterior-posterior diameter of the thorax through rotation of the upper ribs about the costovertebral joint.

Bucket-handle movement: increase in lateral diameter through the outward movements of the lateralmost part of the middle ribs.
Pump-handle movement is displayed mostly by the:
Upper ribs.
Bucket-handle movement is displayed mostly by the:
Middle ribs.
Layers of intercostal muscles:
External intercostals: \\\///;
Internal intercostals: ///\\\;
Innermost intercostals: similar to the internal intercostals.
Which muscles are involved during normal inspiration?
Diaphragm and external intercostals.
Forced inspiration requires aid from which muscles?
Accessory muscles (e.g. scalene muscles, serratus muscles, pectorals, subclavius) to elevate ribs.
Which muscles are involved during normal expiration?
None. Passive recoil of lungs and relaxation of diaphragm.
Which muscles are involved during forced expiration?
Internal intercostals, abdominal muscles.
Nerve supply of the thoracic wall:
Intercostal nerves (anterior rami of T1-T11); Subcostal nerve (anterior rami of T12)
Course of intercostal nerves:
Initially runs in endothoracic fascia between parietal pleura and internal intercostal membrane, pierces innermost intercostals near angles and passes between internal and innermost intercostals, lie in costal groove of rib (inferior to vein and artery), near sternum, pierces muscle and turns anteriorly to become anterior cutaneous branch (divides into medial and lateral branch).
Branches of intercostal nerves:
Collateral branches arise near angle of ribs and run along superior border of the ribs below.

Lateral cutaneous branches arise at midaxillary line.
T1 branch also forms _____ apart from intercostal nerve.
Brachial plexus.
Lateral cutaneous branch of the intercostal nerve from anterior rami of T1 supplies _____. It communicates with which nerves? What does this suggest in terms of referred pain?
Skin of axilla; Intercostobrachial nerve and medial cutaneous nerve of the arm; Referred pain to medial aspect of arm during myocardial ischemia.
Thoracoabdominal nerves are the:
Continuation of 7-11th nerve that continue to supply the abdominal wall.
Intercostobrachial nerve:
From 2nd intercostal nerve which enters and supplies the axilla, communicates with medial cutaneous nerve of the arm.
The intercostal nerves supplies (motor/sensory) to the:
Motor: intercostal muscles.
Sensory: trunk (from posterior midline to anterior midline).
Origin of internal thoracic artery:
Branch of 1st part of subclavian artery at root of neck.
Internal thoracic artery is crossed at the origin by the:
(Ipsilateral) phrenic nerves.
Internal thoracic artery descends into thorax anterior/posterior to costal cartilage and intercostal muscles?
Posterior.
At ___ costal cartilage, the internal thoracic artery divides into _____ and _____ arteries.
6th; Musculophrenic, Superior epigastric.
Branches of the internal thoracic artery:
Gives 1-6 anterior intercostal pairs of arteries; pericardiophrenic artery (supplies pericardium).
Internal thoracic artery provides collateral circulation to _____ in case of blockage of _____.
Abdomen; Descending aorta.
Describe the collateral circulation of of the internal thoracic artery:
Arch of aorta - subclavian artery - internal thoracic artery - anterior intercostal arteries - posterior intercostal arteries - thoracic aorta.
Origin of the posterior intercostal arteries:
1-2: superior intercostal artery (from subclavian artery);
3-11: thoracic aorta
Course of the posterior intercostal arteries:
Courses along with intercostal nerves through intercostal spaces between internal intercostals and innermost intercostals, enters costal groove at costal angle.
Origin of the anterior intercostal arteries:
1-6: internal thoracic artery
7-9: musculophrenic artery
No anterior intercostal arteries in 10-11 intercostal spaces.
Anterior intercostal arteries are paired/unpaired.
Paired.
Describe the general venous drainage of thoracic wall:
Intercostal veins (runs in the costal groove) drain into internal thoracic vein, which drains into the brachiocephalic vein, then into SVC. Some drainage into the azygos venous system and IVC.
Intercostal space is between _____ and _____ muscles:
Internal; Innermost intercostal.
Main neurovascular bundle runs in the _____ on the _____ border of the rib. What is the order of the structures from superior to inferior?
Costal groove; Inferior; Vein, Artery, Nerve (VAN).
Collateral branches order on the _____ border of the _____ rib are ordered in which way?
Superior; Inferior; Nerve, Artery, Vein (reverse!).
Pneumothorax is a condition where:
Accumulation of air in the pleural space (e.g. stab wound).
Pleural effusion:
Accumulation of fluid in the pleural space. 4 types of fluid: serous, blood, chyle, pus.
A chest tube insertion is done for drainage of:
Pneumothorax, pleural effusions etc.
Where should a chest tube be inserted?
Triangle of safety: Latissimus dorsi, pectoralis major and upper edge of 5th rib. Slightly anterior to midaxillary line (to avoid long thoracic nerve) at the 4th intercostal space.
The triangle of safety avoids which major structures for each lung? Which structures has to be avoided in the process of inserting a chest tube?
Right: liver.
Left: spleen, stomach, heart.

Long thoracic nerve; keep needle close to the upper border of the rib to avoid neurovascular structures in the costal groove.
Where should the needle be inserted in a needle aspiration? Usually when is this process carried out?
Midclavicular line, 2nd intercostal space. Tension pneumothorax.
Where should the needle be inserted during thoracocentesis? When is this process carried out? Which structures have to be avoided?
Midaxillary line, angled upward in 9th intercostal space. To sample fluid during pleural effusion. Diaphragm.
Continuity between parietal and visceral pleura forms a:
Pulmonary ligament.
Pleural fluid fills the:
Pleural space.
How does thoracic expansion translate into lung expansion?
Surface tension provided by pleural fluid allows cohesion of the lung surface to the thoracic cage.
Needle aspiration usually done at the _____ recess.
Costodiaphragmatic.
2 types of recesses:
Costodiaphragmatic, costomediastinal.
Trachea forms from larynx at which level?
C6.
Trachea supported by __-shaped rings of _____.
C; Hyaline cartilage.
Which structures/spinal level does the trachea bifurcates at?
Sternal angle, T4.
The part between left and right main bronchi is the:
Carina.
Describe the tracheobronchial tree:
Trachea - main bronchi - secondary (lobar) bronchi - tertiary segmental bronchi - bronchioles - terminal bronchioles - respiratory bronchioles - alveolar ducts - alveoli.
The viewing of tracheobronchial tree is called:
Bronchioscopy.
Tumors in the lungs are surgically resectable because they localise in 1:
Pulmonary segment.
Each pulmonary segment is supplied by its own:
Tertiary segmental bronchi, tertiary branch of segmental artery.
Right lung has ___ lobes.
3.
Left lung has ___ lobes.
2.
Root of lung pass through the _____.
Hilum.
Structures in root of lung:
Main bronchi, Pulmonary artery, Pulmonary veins, Bronchiopulmonary lymph nodes.
Relations at apex of lung (left/right):
Arteries: brachiocephalic artery (R)/ L. subclavian and L. common carotid artery (L);
Vein: Brachiocephalic vein;
Nerve: L/R vagus nerve, recurrent laryngeal nerve, phrenic nerve, T1 sympathetic nerve;
Lymph: Right lymphatic duct (R)/ Thoracic duct (L);
Thymus.
Impressions on right lung in a cadaveric lung:
Superior and Inferior vena cava, Brachiocephalic vein, Azygos vein, Esophagus.
Impressions on left lung in a cadaveric lung:
Subclavian artery, Arch and descending aorta.
Surface markings of parietal pleurae:
Apex: Extends through the superior thoracic aperture into the supraclavicular fossa and lies 2-3 cm superior to the medial 1/3 mark of the clavicle.

Rib 2: Posterior to sternoclavicular joint in midline of sternum.

Rib 4-6: Descends in midline until xiphisternal joint (R); Rib 4: Descends in midline and starts to deviate laterally, Rib 6: Deviates laterally for cardiac notch (L).

Rib 8: Crosses midclavicular line.

Rib 10: Crosses midaxillary line.

Rib 12: Adjacent to vertebral column.
Surface markings of lungs:
Same borders as pleura until rib 4, 2 ribs above for lungs:

Rib 6: Midclavicular line.

Rib 8: Midaxillary line.

Rib 10: Adjacent to vertebrae.
Surface markings of oblique fissures:
Both lungs, from T2 vertebrae to 6th costochondral junction.
Surface markings of horizontal fissures:
Right lung only, from 4th costal cartilage to oblique fissure at midaxillary line.
Areas of auscultation for upper, lower and middle lobes of lung:
Upper lobe: front of chest; Lower lobe: back of chest, below scapula; Middle lobe: anterior surface, 5th intercostal space.

All lobes: Midaxillary line.
Left and right pulmonary arteries arise from the pulmonary trunk at the:
Sternal angle.
Pulmonary arteries contain deoxygenated/oxygenated blood?
Deoxygenated.
Pulmonary arteries branch into:
Secondary lobar arteries, tertiary segmental arteries.
Gas exchange occur at:
Capillary beds of alveoli.
How many pulmonary veins are there in total?
4 (superior and inferior on each side).
Right middle lobe vein is a tributary from which vein?
Superior pulmonary vein.
Major lymph nodes concerning the lung:
Tracheobronchial nodes; Pulmonary nodes; Bronchopulmonary nodes.
Lymph nodes of lung drain into:
Bronchiomediastinal trunks (L and R) which drain into the venous angle (junction between subclavian and internal jugular vein.
Which arteries provide oxygenated blood to the lungs (systemic circulation)?
Small bronchial arteries.
Describe the physiologic shunt in the lungs:
Bronchial veins drain directly into the left atrium (oxygenated) instead of the right, thus diluting the oxygenated blood of the aorta.
Innervation of the parietal pleura:
Nerves supplied to cutaneous layer (diaphragmatic surface: phrenic nerve C3-C5; costal surface: intercostal nerves/subcostal nerve T1-T12).
Pain from the parietal pleura may be referred to which spinal dermatome?
Costal surface: intercostal nerves/subcostal nerve T1-T12; Diaphragmatic surface: phrenic nerve C3-C5.
Visceral pleura is supplied by:
Pulmonary plexus, forms around root of lungs.
Visceral pleura is sensitive/insensitive to pain?
Insensitive, no general sensory innervation.
Sympathetic supply of lungs (pathway, neurotransmitter, effects):
Pathway: postsynaptic sympathetic trunk;
Neurotransmitter: norepinephrine;
Effects: Bronchodilator, vasoconstrictor, inhibition of type II alveolar cells.
Parasympathetic supply of lungs (pathway, neurotransmitter, effects):
Pathway: vagus nerve, synapse in parasympathetic ganglia of pulmonary plexus;
Neurotransmitter: acetylcholine;
Effects: Bronchoconstrictor, vasodilator, secretomotor effects on type II alveolar cells.
Type II alveolar cells:
Secrete surfactant.
Mediastinum covered by a fibroserous membrane called:
Pericardium.
Pericardium deep to:
Mediastinal pleura.
Two layers of pericardium:
Fibrous (superficial) and serous (deep).
Fibrous layer of pericardium continues with _____ layer of great vessels.
Tunica adventitia.
Fibrous layer continues with the _____ of the diaphragm forming the _____.
Central tendon; pericardiophrenic ligament.
Fibrous pericardium also continues with sternum as _____.
Sternopericardial ligaments.
Serous pericardium formed out of which two layers:
Parietal (superficial); Visceral (deep).
Serous pericardium is also the:
Mesothelium.
Visceral layer of serous pericardium is also the:
Epicardium.
Between the parietal and visceral layers of the serous pericardium is the _____, which contains _____.
Pericardial cavity; Pericardial fluid.
Serous pericardium reflect onto each other at great vessels, forming _____.
Pericardial sinuses.
Reflections of serous pericardium onto each other at great vessels form:
Pericardial sinuses - Transverse and oblique.
Transverse pericardial sinus is between:
Pulmonary artery (and ascending aorta) and pulmonary vein.
Clinical significance of transverse pericardial sinus:
Ligation during surgery.
Oblique pericardial sinus is between:
Pulmonary veins and IVC.
Arterial supply to pericardium:
Pericardiophrenic artery (branch of internal thoracic vein)
Venous drainage of pericardium:
Pericardiophrenic vein or occasionally azygos veins.
Innervation of pericardium:
Sympathetic innervation: sympathetic trunk (vasomotor);
Sensory innervation: phrenic nerves (C3-C5)
Vagus nerve - function uncertain.
Phrenic nerve supplies which dermatomes? What is the clinical significance of this?
C3-C5. Referred pain to over the shoulder.
Where should pericardiocentesis be carried out?
5th intercostal space, near the sternum.
Surface marking of apex beat:
5th intercostal space, midclavicular line.
Apex of the heart is formed by:
Left ventricle.
Base of the heart is formed by:
Left atrium.
Apex beat is the result of the closure of the _____ valve.
Mitral/bicuspid.
Layers of walls of heart:
Epicardium (visceral layer of serous pleura); myocardium; endocardium.
Which structure demarcates atria from ventricles?
Coronary sulcus.
Which structure demarcates right from left ventricles?
Interventricular sulcus.
Coronary sinus opens into which chamber?
Right atrium.
Valve cusps (of bicuspid and tricuspid) are held by _____ and _____.
Chordae tendinae; papillary muscles.
Auricles can be found in atrium/ventricles.
Atrium
Muscles on wall of atrium:
Pectinate muscle.
Smooth and rough surfaces of wall of atrium are due to:
Smooth surface: sinus venarum (posterior); Rough surface: pectinate muscle (anterior).
Embryological origin of sinus venarum:
Sinus venosus.
Between smooth and rough surfaces, demarcated by:
Sulcus terminalis (externally) and cristae terminalis (internally).
Remnant of feral foramen ovale becomes _____, located in _____.
Fossa ovalis; Right atrium (in left atrium, floor of fossa ovalis is observed).
Muscular elevations in left ventricle muscle:
Trabaculae carnae.
Connections of septomarginal trabecular (physiology):
Right ventricle to inferior part of IVS to base of anterior papillary muscle.
Aortic and pulmonary valves are:
Semilunar valves.
Semilunar valves have ___ cusps?
3.
Right and left coronary arteries arise from:
Right and left aortic sinus.
Surface marking of the heart:
1) 5th L. intercostal space, 8cm from midline;
2) 2nd L. intercostal space, 4 cm from midline;
3) 6th R. intercostal space, 4 cm from midline;
4) 3rd R. intercostal space, 4 cm from midline.

1-2 convex line, 4-1 straight line, 3-4slightly convex line, 2-3 great vessels.
Auscultation of the 4 heart valves:
Aortic valve: R. 2nd intercostal space, sternal border;
Pulmonary valve: L. 2nd intercostal space, sternal border;
Tricuspid valve: L. 4th intercostal space, sternal border;
Bicuspid valve: APEX BEAT, L. 5th intercostal space, midclavicular line.
Stenosis of heart valves mean that:
Valves fail to open fully - slows flow of blood.
Incompetent and insufficient valves mean that:
Valves fail to close fully - regurgitation and turbulence compromising cardiac output.
Valve prolapse mean that:
Valves extend back into the atrium during systole - regurgitation.
A collapsing pulse is a sign of:
Aortic incompetence.
Course of left coronary artery:
Courses between left auricle and pulmonary trunk and enters coronary sulcus (AV groove).
Course of right coronary artery:
Courses between right auricle and pulmonary trunk and enters coronary sulcus (AV groove).
Main branches of left coronary artery:
Left circumflex branch (gives of left marginal artery); Left anterior descending/IV branch; SA nodal branch.
Main branches of right coronary artery:
Right marginal branch; Posterior descending/IV branch; AV nodal branch.
SA node is supplied mostly by ____ coronary artery?
Left.
AV node is supplied mostly by ____ coronary artery?
Right.
Possible anastomosis of the coronary arteries:
Coronary sulcus: Right coronary artery - Left circumflex branch of left coronary artery.

Interventricular groove/sulcus: Left anterior descending branch of left coronary artery - Posterior descending branch of right coronary artery.
Branches of coronary arteries are considered to be _____, thus lacking sufficient anastomosis during occlusion.
Functional end arteries.
Blockage of coronary vessels result in:
Myocardial infarction.
Ischemia of coronary vessels result in:
Angina pectoris.
Coronary veins drain into _____ (then into _____), which travels along the _____ from _____ to _____ along the _____ surface.
Coronary sinus (Right atrium); Coronary sulcus; Left; Right; Posterior.
Coronary veins of the heart:
Great cardiac vein (gives off oblique vein of left atrium), middle cardiac vein, small cardiac vein.
Great cardiac vein travels along:
Left anterior descending branch, then left circumflex branch (note direction of blood flow is the same here!) into coronary sinus.
Middle cardiac vein travels along:
Posterior descending branch (of right coronary artery) into coronary sinus.
Small cardiac vein travels along:
Right marginal branch (of right coronary artery into coronary sinus.
Coronary arteries and veins supply and drain from which layers of the heart?
Epicardium and myocardium.
The endocardium and subendocardial tissue receives oxygen and nutrients by:
Diffusion or microvasculature directly from the chambers of the heart.
Sinuatrial node located at:
Junction of SVC and RA.
Sympathetic innervation of the heart: (Pathway, Neurotransmitter, Effects)
Pathway: postsynaptic fibres from sympathetic trunks of T1-T4 via cardiopulmonary splanchnic nerves.

Neurotransmitter: norepinephrine.

Effects: increased rate of depolarisation of SA node, increased contractility, vasodilation of coronary arteries.
Parasympathetic innervation of the heart:
Pathway: presynaptic fibres from vagus nerve, synapse on ganglia at atrial wall and interatrial septum and along coronary arteries, to postsynaptic fibres in cardiac plexus (on anterior surface of bifurcation of trachea, posterior to ascending aorta).

Neurotransmitter: acetylcholine.

Effects: decreased rate of depolarisation of SA node, decreased contractility, vasoconstriction of coronary arteries.
Afferent visceral pain fibres of the heart follow:
Sympathetic nerves via cardiac plexus, white rami, to T1-T4 spinal levels.
Referred pain of the heart is referred to:
T1-T4 dermatomes, radiating down the left arm (since T2 2nd intercostal nerve is joined to medial cutaneous nerve by intercostobrachial nerve, supplying axillary skin and medial side of upper arm).
Ascending aorta is intra/extrapericardial?
Intrapericardial.
Arch of aorta begins at:
Posterior to 2nd right sternocostal joint, anterior to pulmonary artery. Arches over root of left lung and descends posterior to root of left lung.
Descending (thoracic) aorta begins and ends at:
T4 - T12, passes through aortic opening of diaphragm to become abdominal aorta.
Descending aorta is on left/right side of esophagus?
Left.
Branches of ascending aorta:
Coronary arteries (left and right).
Branches of arch of aorta:
(Right) brachiocephalic trunk - bifurcates at sternoclavicular joint and divides into right subclavian and right common carotid; Left subclavian; Left common carotid artery.
Branches of descending aorta:
Posterior intercostal arteries (9); Subcostal arteries; Brachial arteries; Esophageal arteries.
Ligamentum arteriosus is the remnant of the:
Fetal ductus arteriosum.
Remnant of the fetal ductus arteriosum is the:
Ligamentum arteriosus.
Ligamentum arteriosus connects the:
Bifurcation of the pulmonary trunk to the lower concave surface of the aortic arch.
Hooking around the arch of aorta is the:
Left recurrent laryngeal nerve, from left vagus nerve.
Pathway of femoral catheter:
Femoral artery - external iliac artery - common iliac artery - abdominal aorta - thoracic aorta - arch of aorta - ascending aorta - aortic sinuses - aortic valve - left ventricle.
Brachiocephalic vein is joined by which two veins? What is this union called? Where is it located?
Internal jugular vein and subclavian vein. Venous angle. Posterior to sternoclavicular joints.
SVC is formed by the union of _____ at _____.
Left and right brachiocephalic veins; 1st right costal cartilage.
SVC travels between:
Trachea (posterior to SVC) and aorta (anterior to SVC)
SVC terminates and enters right atrium at:
3rd costal cartilage.
The SVC drains all the structures superior to the ______, except which organs?
Diaphragm; lungs and heart.
The _____ gives off the azygos vein at which level?
SVC; T5.
Origin of IVC:
Arises in the abdomen by union of the common iliac veins.
The IVC pierces the ______ of diaphragm at which level?
Central tendon; T8.
IVC terminates and enters the right atrium at:
T7.
Function of azygos and hemiazygos vein:
Provides collateral circulation for SVC and IVC.
Azygos and hemiazygos veins are on which side of the vertebrae?
Azygos: right; Hemiazygos: left.
Lymphatic drainage of the thorax:
Superficial anterior thoracic wall: anterior axillary nodes;
Superficial posterior thoracic wall: posterior axillary nodes;
Deep anterior intercostal areas: parasternal nodes which drain into the bronchomediastinal trunk.
Deep posterior intercostal areas: posterior intercostal nodes, which drain into the thoracic duct.
Thoracic duct arises from the _____ in the abdomen.
Cisterna chyli.
Course of thoracic duct:
Enters through aortic opening of diaphragm, on RHS of aorta, crosses to left border of esophagus at sternal angle, follows esophagus up to the root of the neck.

Loops around carotid sheath, in front of vertebral vessels, then crosses subclavian artery to enter the left brachiocephalic vein at left venous angle.
Right lymphatic duct receives lymph from:
Right bronchomediastinal, jugular and subclavian trunks.
Right lymphatic duct drains into:
Right brachiocephalic vein at right venous angle.
Thoracic duct drains the:
Whole body except the parts drained by the right lymphatic duct (right head and neck, upper limb, and upper thorax).
Nerves in the thorax:
Vagus nerve, phrenic nerve.
Origin of the phrenic nerve:
C3-C5 spinal root, anterior rami.
The right phrenic nerve courses:
On the right of the right brachiocephalic vein.
The left phrenic nerve courses:
On the left of the left subclavian artery.
The phrenic nerves course with what structures along the sides of the pericardium?
Pericardiophrenic nerve and artery.
Phrenic nerve provides motor innervation to:
Ipsilateral side of the diaphragm.
Phrenic nerve provides sensory innervation to:
Diaphragmatic/mediastinal parietal pleura, pericardium, peritoneum covering central diaphragm.
Origin of the vagus nerve:
Brainstem.
The left vagus nerve courses:
Between the common carotid and the subclavian arteries.
The right vagus nerve courses:
Posterolateral to the brachiocephalic trunk.
The phrenic nerve passes anteriorly/posteriorly to root of lungs?
Anteriorly.
The vagus nerve passes anteriorly/posteriorly to root of lungs?
Posteriorly.
Vagus nerve forms which plexuses before passing through the diaphragm?
Pulmonary, cardiac, esophagus
The thoracic duct passes through which opening of the diaphragm?
Aortic.
The vagus duct passes through which opening of the diaphragm to reach posterior stomach?
Esophageal.
Significant branch of the vagus nerve:
Left and right recurrent laryngeal nerves.
Right recurrent laryngeal nerve hooks around the ______ to supply the ______.
Right subclavian artery; intrinsic muscles of the larynx except the cricothyroid muscles.
Left recurrent laryngeal nerve hooks around the ______ to supply the ______.
Arch of aorta, lateral to ligamentum arteriosum; intrinsic muscles of the larynx except the cricothyroid muscles.
Left recurrent laryngeal nerve likely to get injured in a:
Aneurysm of the arch of aorta.
Sympathetic trunk is visible in the:
Posterior mediastinum, lateral to the vertebral column.
Thymus is located in the:
Inferior neck, anterior superior mediastinum.
Esophagus begins form _____ at which level?
Laryngopharynx; C6.
Esophagus passes through oesophageal hiatus at which level?
T10.
Esophagus enters _____ of the stomach at which level?
Cardial orifice; T11.
Constrictions of the esophagus:
1. At junction of pharynx and oesophagus.
2. Where aortic arch and left bronchus cross anteriorly.
3. Where oesophagus passes through the diaphragm.
Arterial supply of the esophagus:
Superior 1/3: Inferior thyroid artery;
Middle 1/3: Descending aorta;
Inferior 1/3: Left gastric artery.
Venous drainage of the esophagus:
Superior 1/3: Inferior thyroid vein;
Middle 1/3: Azygos vein;
Inferior 1/3: Left gastric vein.
Lymphatic drainage of the esophagus:
Superior 1/3: Deep cervical nodes;
Middle 1/3: Mediastinal nodes;
Inferior 1/3: Celiac nodes and nodes at left gastric blood vessels.
Nerve supply of the esophagus:
Sympathetic: sympathetic trunk;
Parasympathetic: esophageal plexus from the vagus nerve.
Close proximity of the ____ to the esophagus.
Left atrium.
Relations at superior mediastinum (from anterior to posterior):
Thymus - veins - arteries - trachea - esophagus - thoracic duct.
Relations at the sternal angle (T4):
Anterior mediastinum: skin and fascia - sternum - internal thoracic artery and vein - thymus;

Middle mediastinum: veins (SVC, brachiocephalic vein) - arteries (arch of aorta) - pretracheal lymph nodes - trachea - arch of azygos vein - esophagus - thoracic duct and lymphatic trunks;

Posterior mediastinum: T4 vertebrae - spinal cord - rhomboid and trapezius.

Laterally: phrenic nerve - main bronchi - vagus nerve - sympathetic trunk - scapula and muscles.